Dr. Henry Paul, MD

Psychiatrist, Author and Educator

AM I MISSING THE SYMPTOMS OF SEXUAL ABUSE WITH MY CHILD?

October 31st, 2014

For starters, I will tell you that sexual abuse is hard to diagnose in children while it is happening because fully 25 to 35 percent of victimized children show no symptoms of the abuse. However, two-thirds do develop symptoms, which may range from anxiety, dissociation, depression, sexualized behaviors, bedwetting or expressions of anger to a general decline in social, academic, and overall functioning. Studies of children who have been sexually abused indicate that 60 to 70 percent develop a psychiatric disorder – most commonly PTSD (Post Traumatic Stress Disorder), but also various behavior, anxiety, depressive and dissociative disorders.

Dissociative disorders may include avoiding people, numbness, daydreaming, obsessive fantasizing, depersonalization (objectifying oneself to others), and such somatic complaints as fainting and feelings of physical helplessness.

PTSD from sexual abuse leads to high anxiety. The victim often relives the experience in flashbacks and sometimes reenacts the trauma through sexual acting out. These children often battle depression. Sometimes this depression can become suicidal; the child’s core identity is so fundamentally disturbed that he or she feels hurt beyond repair. Such children also become enraged and quick to act out with other people, whether adults or friends and classmates their age.

Children who are sexually abused may also act out sexually in highly inappropriate ways with other adults they meet. They often have confused ideas about sexuality, closeness and intimacy.

Not every child experiences these severe reactions; it depends on the nature of the abuse the temperament and age of the child. However, clearly some very serious psychic consequences can develop from sexual abuse, and parents need to take seriously any indications that it may be occurring now or has occurred in the past.

If you as a parent suspect that your child has been sexually abused and your child has, in fact, disclosed this, you should listen and be understanding. Reassure your child that he or she should not feel guilty and that they did the right thing by disclosing the abuse. Children should not be blamed for being victims of sexual abuse even though we are anxious and often angry at the time of disclosure. Parents have to offer protection.

Parents should report any suspicion of child abuse to Child Protective Services if it happens inside the family, or to the police or the district attorney’s office if it occurs outside the family.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

SEXUAL ABUSE – THE NUMBERS ARE HIGHER THAN REPORTED

October 29th, 2014

Rep. George Miller of California says a new GAO report points out important gaps in the nation’s systems for reporting child abuse by school personnel. NBC NEWS

An interesting NBC News story that I came across last weekend says that “Sexual abuse of children by teachers or other public school employees is likely underestimated because of a patchwork reporting system and involvement of numerous local, state and federal agencies in investigating such claims.”

This is according to a report released by the U.S. General Accounting Office (GAO) in January of this year. The report, “Child Welfare: Federal Agencies Can Better Support State Efforts to Prevent and Respond to Sexual Abuse by School Personnel” was presented to various members of Congress and to The Honorable George Miller, Ranking Member Committee on Education and the Workforce, House of Representatives.

In the report, a letter addressed to Miller in January 2014 outlines the situation. “Over the last decade, a number of media reports were made across the country about sexual abuse¹ of students by public K-12 school personnel. A report prepared for the U.S. Department of Education in 2004 stated that nearly 9.6 percent of students are victims of sexual abuse by school personnel²—such as teachers, principals, coaches, and school bus drivers—sometime during their school career.³

I saw this trend back in 2000, and I wrote about it in my book, “Is My Child Okay?” At that time, according to state child abuse registries, sexual abuse – the exploitation of a child by an adult to satisfy the adult’s sexual desires – accounted for ten percent of all reported cases of child abuse. The operative word is reported. In fact, the actual incidence of sexual abuse of children was more realistically closer to 20, 25 or even 30 percent. Many children don’t disclose the abuse and adults similarly hide their participation in it.

In the mental health arena, many of us can confidently say that the numbers of children sexually abused are much higher. Why? Because of the number of adults who eventually come forward. As many as 20 to 40 percent of adult women and 10 percent of adult men admit to having experienced some form of sexual abuse as a child. Hard to believe? The Jerry Sandusky case at Penn State is a good example of this.

To add to these statistics, 40 percent of children who are abused experience it only once in their lives, but an appalling 60 percent experience it many more times, often over a period of years. Both boys and girls, from infancy to adolescence, may be abused, although girls appear to be the more usual victims – some reliable study statistics indicate that as many as one in every six girls is sexually exploited by an adult. These are frightening numbers! The way to change this is through education and support. Topics I will tackle in my next couple of blogs.

Definitions of sexual abuse may vary from state to state. For example, sexual abuse may be defined in general terms or by specifying various acts as sexual abuse, such as rape, molestation, or sexual assault. For purposes of this report, we consider sexual abuse to include any sexual activity involving a child that is a crime under applicable state law. However, the prevalence of sexual abuse by school personnel remains unknown, in part, because some cases go unreported.
For the purposes of this review, school personnel includes a wide variety of positions including, but not limited to, school district administrators, principals, teachers, paraprofessionals, school nurses, coaches, guidance counselors, school psychologists, school cafeteria staff, janitors, and school bus drivers.
Shakeshaft, C, Educator Sexual Misconduct: A Synthesis of the Literature, U.S. Department of Education, 2004. The estimate provided in the report is the most recent information available on the prevalence of such abuse and misconduct and is based on secondary analysis of data collected for the American Association of University Women in Fall 2000 from a sample of 8th through 11th grade students in 80,000 schools and focused on experiences that occurred in school.

DISCLAIMER

HOW MANY TIMES DO WE HAVE TO SAY “NOT ONE MORE?”

October 25th, 2014

I was watching the news unfold yesterday about the shooting in a Seattle high school. Listening to a few students tell what happened was chilling. I am saddened to hear these stories over-and-over and to know that, unfortunately, these shootings have become more commonplace than any one of us ever could have imagined.

In yesterday’s shooting, one student and the student-shooter were killed, and three other students were critically injured.

Student Austin Taylor recounted to KING News what happened in the cafeteria.
“I was sitting at the table right next to the round table (where the shooter was). I just got done eating my food. He was quiet, everyone was talking. All of sudden he stands up, pulls something out of his pocket. At first I thought it was someone making a really loud noise like a bag, a loud pop. There were four more after that. I saw three kids just fall from the table, like they were falling to the ground dead. I jumped under the table as fast as I could. When it stopped, I got back up and saw he was trying to reload his gun. And when that happened, I just ran in the opposite direction and I was out of there as fast as I could.”

I have said before, we could use better gun control laws in this country, but I don’t believe that those laws, necessarily, will prevent the gun violence that results in mass shootings. What we need is to focus more on student-mental health and mental health in general, in this country.

I want to be clear that mental health issues do not mean a person is going to become violent, so we certainly should not stereotype. If anything we should be breaking down the stereotypes of mental illness so that the stigma attached goes away. What I am saying is that the perpetrators of the thirty some-odd mass shootings since Columbine in 1999, most likely had some form of mental illness, that coupled with other issues (social, family, etc.) led to them making their decision to become violent.

Over the years, students, teachers, parents and school administrators have become more aware of some of the signs that might imply someone is planning a violent attack. In my May blog “Not One More”, I provided a short list of some behavioral changes that should be of concern including:

Increased anger, aggression, tantrums, irritability, and revenge episodes especially when you can’t make any sense of the situation and the person seems more depressed, isolated and unruly than usual.
The appearance of strange ideas especially having to do with anti-government themes, conspiracy theories, and other paranoid trends especially if accompanied by hearing voices.
Interest in and ownership of weapons that are a new or heightened twist for the individual.
Overt or thinly veiled threats, writings, interest in and worship of lethal ideas towards self or others, including suicide.
Increase in substance use by people with a history of violence and especially in those who have been treated for a severe psychiatric illness who have stopped their medication.

The important thing is for all to continue to be vigilant. Students should take threats they see on social media, overhear or that are said to them, and report these threats to parents, teachers, coaches, school administrators or law enforcement. It has been proven in many cases that reporting these incidences has prevented other tragedies like the one today.

DISCLAIMER

WHAT TO TELL YOUR CHILDREN ABOUT EBOLA

October 19th, 2014

It is scary to watch the news and hear about Ebola. With a 24-hour news cycle making Ebola the top news it’s no wonder that adults and young people are confused, scared and anxious about this disease. Hearing that two schools closed in Ohio last week because of Ebola, and then that a nurse traveled on a commercial flight and that health officials are now contacting all the passengers, is frightening.

It’s important to speak with your children about Ebola. Having said that, it is important for parents first to understand the disease and to calm their fears and anxieties, as children often take their cues from parents on how to react in difficult situations. The younger the children, the more likely they are to watch your reaction to the news rather than the news itself.

There is some good information out there about Ebola. The disease is rare, but it does cause severe illness. Here is a link to a very good overview of the disease that includes symptoms and treatment. Once you are comfortable with your understanding of the disease then, you should set aside some time to sit down with your child or children together. Listen to their concerns and fears. There are no “right” or “wrong” answers when discussing their concerns. Just try to be comforting and informative. Answer their questions honestly and assure them that you understand their anxiety about the Ebola. Explain the facts and offer them assurances in a language that is appropriate for their age. Make sure that the details you share are also age appropriate. With older children you may want to go online with them to look at fact sheets or visit sites like the CDC, WHO or a news site that you feel appropriately addresses the issues without an over-abundance of fear added in. Realize that that your child or children may come back to you many, many times with new questions and looking for additional assurances over the next few weeks or months or however long Ebola dominates the news.

The American Academy of Child & Adolescent Psychiatry has a good checklist for talking with your children. Click here to read it.

In an article that appeared on WBUR’s Common Health on October 2nd, we are reminded that the United States is capable of dealing with this disease and that there are other diseases that can cause more harm based on the chance a child will get it. “……Experts agree that our medical infrastructure is well-equipped to handle even a virus as scary as Ebola, and some doctors are quick to point out viruses like respiratory syncytial virus (RSV) and influenza are much more likely to cause harm than these new ones.”

For parents, who after speaking to their child, are concerned that their child is still obsessed and anxious about Ebola, they should speak with a mental health professional (i.e. school social worker, pediatrician, child psychiatrist).

DISCLAIMER

WHO IS THAT EXPERT ANYWAY?

October 15th, 2014

Over the years, parents have come into my practice questioning whether-or-not medication is necessary, and safe, for their child. They listen to the radio, see an expert on television, or find a website or blog online, and all of a sudden they are not sure what to believe. Parents have become frightened about medicating their child. Here are some comments that I received from parents worried about medication:

“These drugs are harmful – we don’t even know how they work.”
“There is nothing really wrong with my child; it’s just a bit of extreme behavior, certainly not a disorder.”
“My neighbor’s daughter died from that medication.”
“I heard these medications are addictive.”
“I just want to use natural remedies.”
“I don’t want my son to be a zombie all day.”
“I’m afraid the side effects will be worse than the disorder.”

From years of practice and education, I have become familiar with the arguments about the use, and possible misuse, of psychotropic medication for young people. While good healthy debate helps us all, this subject has also attracted many who distort, exaggerate, and even make up stories.

Having been interviewed myself on many radio and television programs to discuss this medication and more, I have seen the dangers of relying on sound-bite newscasts or talk show drama when it comes to terribly important topics. I have learned that many of the experts have had little or no experience working in the trenches with children. The problem is that the “experts” on television and radio, or who have a blog, are assumed to be knowledgeable.

One interview I did was for a national talk show viewed by millions of parents. I was talking about the medication used for ADHD with another doctor who had written a popular book against the use of any medication for this disorder. During a commercial break, I asked the author how he had become so convinced that medications are dangerous, as I had never seen many of the problems he was describing. He told me that he was not a child psychiatrist, but a family medicine practitioner for adults and he had never even treated a child or teenager with ADHD. He said he had written his book based on a literature search he had done on his computer. His book was doing well, and the audience warmed to his comments, as he tapped into the great anxieties that most people have about giving their children medication. I was concerned that parents listening to him might withdraw life-saving, school-saving, family-saving, abuse-saving medication treatments because of his biased arguments – arguments not based on facts or experience.

As a licensed psychiatrist specializing in children and adolescents, I have spent over thirty years treating children in the trenches. I have seen children in nearly all settings, including hospitals, outpatient public clinics, residences, foster agencies, and in private practice. I have evaluated, treated and prescribed medication for thousands of children and teenagers and have followed the progress of many of them over the course of many years. That is why I wrote, “When Kids Need Meds; Everything a Parent Needs to Know about Psychiatric Medication and Youngsters.” While I certainly don’t believe that all children with mental disorders need medication, I strongly feel that some do. To withhold these important therapeutic agents can be harmful and, in some cases, tragic. I have a deep sympathy for the children who suffer from mental problems and equal compassion for their parents. I respect the need for sound information, informed reassurance, and ongoing guidance during the time a child is being treated.

DISCLAIMER

CHILDREN WITH MENTAL ILLNESS AND THE PARENTS WHO LOVE THEM

October 7th, 2014

Every Mom’s Worst Nightmare; Coping with a Child’s Mental Illness was a great segment recently on CBS News. I highly recommend you take a few minutes and watch it.

Do children really suffer from mental disorders? Isn’t that only the domain of adults? Unfortunately, no. It might be helpful to consider the numbers. There are approximately 75 million children and teenagers in the country. About one-in-five young people less than eighteen-years-old are thought to suffer from a bona-fide mental disorder. That is at least 15 million of our youth. In that number, approximately half suffer from a serious mental disturbance, and about half of those suffer from what is called an extreme disturbance.

In the CBS segment, Mom Liza Long tells how she felt on the day of the Sandy Hook shooting.

“I just put my head down on my desk and started to cry,” Long, 42, told CBS News. But it wasn’t that Long knew any of the families that had lost a child. “I had children about that age too. It’s every mom’s worst nightmare. But I realized right away it’s every mom’s worst nightmare on two fronts, not just one.”

Her first thought, she later wrote, was “What if my son does that someday?”

Only a day before Sandy Hook, Long had to forcibly restrain her second oldest son, Michael — then 13 — to prevent him from running out into oncoming traffic, and then had him transported to an acute care psychiatric hospital.

Realizing that your child has a problem is scary. It can be devastating to learn that your child is physically sick, but discovering that your child suffers from a mental disorder adds another layer of confusion and anxiety. Mental disorders are not as well understood as physical disorders, and it is only recently that they have begun to be talked about openly. The school shootings have really focused the microscope on mental health as the root of the problem, not just the accessibility of guns.

Long’s story opens a new dialogue for parents of children with severe mental disorders. Raising a child with these issues is complicated, scary and often-time daunting for parents, caregivers and the medical professionals who are trying to help.

In the CBS interview, Long tells about the night of the Sandy Hook shooting when she returned home and wrote her blog entry, “Thinking the Unthinkable” on her blog, “The Anarchist Soccer Mom.” It was her call to action.

(From the CBS interview):

“I am sharing this story because I am Adam Lanza’s mother. I am Dylan Klebold’s and Eric Harris’s mother. I am James Holmes’s mother. I am Jared Loughner’s mother. I am Seung-Hui Cho’s mother. And these boys–and their mothers–need help. In the wake of another horrific national tragedy, it’s easy to talk about guns. But it’s time to talk about mental illness,” said Long.

Long had been telling her story anonymously for years, but this time she made the decision to put her name to the story. “I live with a son who is mentally ill. I love my son. But he terrifies me,” she wrote. The blog post went viral, generating more than a million ‘likes’ on Facebook and 30,000 email replies.

I applaud Long for speaking out about her child and her struggles to parent a child with such a mental disorder. We need to be having more dialogues about how to address these mental disorders so we can come up with a better support system for the families and better treatment for the children. We need to be able to diagnose better, offer more support, and make it less bureaucratic for the system to work for those families in need.

You can follow Long on her blog the Anarchist Soccer Mom.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

YES, YOU SHOULD VACCINATE YOUR CHILD!

October 3rd, 2014

Public health officials say they’re alarmed at the growing number of cases of measles and whooping cough. They blame parents who are now refusing to immunize their kids. And it’s happening mostly in wealthy communities. “Vaccination Refusals are Alarming Health Officials,” CBS News, 9/27/2014

The spike in the number of parents in affluent California communities who are deciding not to vaccinate their children is on the rise, and reigniting the debate over vaccinations. In Santa Monica and Malibu, nearly 15 percent of kindergarteners are not immunized. That’s a startling number considering that the Center for Disease Control (CDC) says public health is compromised when more than 8 percent of students are not immunized.

Sadly, children in the United States still get vaccine-preventable diseases. As more and more families choose not to vaccinate the resurgence of measles, mumps and whooping cough (pertussis) continues to increase. In 2010, the U.S. had over 21,000 cases of whooping cough reported and 26 deaths, most in children younger than six months.

“If you are unvaccinated and you come in contact with measles, there’s a 90% chance you will get it,” says Jason McDonald, a spokesperson for the Centers for Disease Control and Prevention (CDC), in TIME magazine earlier this year.

Parents need to understand that vaccinations are only given to children after extensive research has been done to make sure that the benefits out-weigh the risks. All parents want to do what is best for their children to keep them safe. You buy the perfect car seat for your newborn, the best protective gear for your teenage soccer player, sunglasses for your toddler to protect her eyes, and the list goes on. Well, vaccinations should be part of the list, too.

I am the author of four books, and my latest book “When Kids Need Meds” addresses concerns parents might have about medicating their kids. Parents struggle with fear and apprehension when having to treat their children with medications. Many of these are the same concerns that they have when considering vaccinations. What I can say is that it is important for your child and society that your child be vaccinated. Luckily, 90% of students entering Kindergarten in the United States in the 2012 – 2013 school year were vaccinated (check out the report here).

What would happen if we stopped vaccinations? According to the CDC, we could soon find ourselves battling epidemics of diseases we thought we had conquered decades ago. To learn more about the importance of vaccinating visit CDC: Vaccines & Immunizations.